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General NPI Number Information
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NPI Number | 1669927307
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Entity Type | Organization
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Legal Business Name | DENTAL DEPOT OF HIGHLAND VILLAGE
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 2460 FM 407
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City | HIGHLAND VILLAGE
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State | TX
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Zip | 75077-3091
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Country | US
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Telephone | 972-966-1234
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Fax | 972-966-1233
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Provider Business Mailing Address
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Address Line | PO BOX 561205
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City | THE COLONY
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State | TX
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Zip | 75056
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Country | US
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Telephone | 972-703-2525
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Fax | 972-332-0141
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Authorized Official
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Title or Position | CEO
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Name | DR. HIMESH I KANA
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Credential | DDS
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Telephone | 972-703-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | TX
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